title: Laparoendoscopic single-site pyeloplasty: outcomes of an international multi-institutional study of 140 patients.
abstract: OBJECTIVE
  To report an international, multi-institutional series of laparoendoscopic single-site pyeloplasty (LESS-P) with analysis of functional outcomes.
  
  
  METHODS
  LESS-P cases performed between October 2007 and June 2012 at 7 institutions worldwide per individual institutional protocols, entry criteria, and techniques were included. Patient characteristics, operative indications, perioperative outcomes, and postoperative follow-up were retrospectively collected and analyzed.
  
  
  RESULTS
  The study included 140 adult patients (age 39.9 ± 15.7 years; body mass index 24.8 ± 4.2 kg/m(2); 15% with previous abdominal surgery) who underwent unilateral LESS-P, most of whom (94.3%) had dismembered reconstructions. Mean operative time was 202.1 ± 47 minutes with an estimated blood loss of 61.2 ± 44.6 mL. Robotic laparoendoscopic single-site surgery was applied in 31 patients (22.1%). A single 2-3 mm accessory port was used in 44 patients (31.4%) and a single 5-12 mm accessory port was added in 9 patients (6.4%), whereas 10 patients (7.1%) were converted to conventional multiport laparoscopy. No patients required conversion to open surgery, nor were any intraoperative complications reported. Length of hospitalization was 2.4 ± 1.6 days. The overall 90-day postoperative complication rate was 18.6%, mostly low-grade complications (Clavien I-II). With a mean follow-up of 14.0 ± 10.8 months, 93.4% had resolution of symptoms and 94.4% had radiographic evidence demonstrating resolution of ureteropelvic junction obstruction. Assessment of drainage with diuretic nuclear renal scan provided evidence of improvement in 86.5% of patients on their first postoperative renal scan.
  
  
  CONCLUSIONS
  This study highlights the most comprehensive experience with LESS-P reported to date. Outcome measures parallel those of large published series of conventional laparoscopic pyeloplasty. Despite these encouraging findings, longer follow-up is needed to determine the efficacy and durability of this approach for the treatment of ureteropelvic junction obstruction.
authors.affiliation: The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY, USA. soroushraisbahrami@gmail.com
authors.forename: Soroush
authors.initials: S
authors.lastname: Rais-Bahrami
authors.forename: Emad R
authors.initials: ER
authors.lastname: Rizkala
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Cadeddu
authors.forename: Volkan
authors.initials: V
authors.lastname: Tugcu
authors.forename: Ithaar H
authors.initials: IH
authors.lastname: Derweesh
authors.forename: Aly M
authors.initials: AM
authors.lastname: Abdel-Karim
authors.forename: Akihiro
authors.initials: A
authors.lastname: Kawauchi
authors.forename: Arvin K
authors.initials: AK
authors.lastname: George
authors.forename: Riccardo
authors.initials: R
authors.lastname: Autorino
authors.forename: Aditya
authors.initials: A
authors.lastname: Bagrodia
authors.forename: Erkan
authors.initials: E
authors.lastname: Sonmezay
authors.forename: Salah
authors.initials: S
authors.lastname: Elsalmy
authors.forename: Michael A
authors.initials: MA
authors.lastname: Liss
authors.forename: Brian M
authors.initials: BM
authors.lastname: Harrow
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
authors.forename: Lee
authors.initials: L
authors.lastname: Richstone
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stein
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000601:surgery*; D055815:Young Adult